“AI is a powerful tool that assists humans with better decision-making and has enormous potential to cut costs and increase effectiveness across the revenue cycle.”

So said Matt Hawkins, a revenue cycle AI industry expert and CEO of Waystar, a revenue cycle platform provider, in a recent interview at HealthLeadersMedia. 

Despite the potential, however, Hawkins noted that healthcare administrators are still lagging behind other industries when it comes to adopting AI. “While industries like banking have utilized artificial intelligence for a long time,” he said, “the revenue cycle still relies largely on manual processes. I think that because we don't have a clear picture of what AI looks like in healthcare, it leads to misconceptions on both ends of the spectrum: you have some people who fear AI will replace humans because it does too much, and others who are disappointed in the functionality and think it does too little.”

The reality, according to Hawkins, is that AI has something to offer nearly every step of the revenue cycle management process.  For example, take the task of predicting claims denials. As Hawkins sees it, “Providers face the difficult task of minimizing denials from payers, while still processing claims fast enough to keep the practice running. Without insight into the likelihood of denial, provider teams often waste time working on the wrong claims. What AI can do is predict denials with a high degree of accuracy and precision and build that into the workflow prior to claim submission. By learning overarching patterns and probabilities of claim denials, AI can guide humans on where to focus their efforts in order to maximize the amount of payment received.”

Once a claim has been submitted, Hawkins says, AI can help providers get payment from payers by “interpreting prior history to determine how long it will take a specific payer to settle a claim. AI tools can show, statistically, when a claim has gone unpaid for an irregularly long time and requires human intervention. Again, this increases efficiency for healthcare administrators, helping them manage their time so they can direct their efforts to more important tasks.”

Patients, too, can benefit from AI tools in the revenue cycle process.  Says Hawkins, “as patient financial responsibility continues to grow, it is crucial for providers to provide a seamless, consumer-friendly billing experience while safeguarding a healthy revenue flow. AI tools can interpret data to model a patient's propensity to pay, and then offer insights on how to send the right follow-up message at the right time for that patient.”

In short, says Hawkins, given the ever-mounting pressure on providers to get both their operating costs and their payment flows in order, “(i)t’s more important than ever for healthcare organizations to ensure that their billing practices are as accurate, efficient, and straightforward as possible, and AI is the most powerful tool available to achieve that goal.”